Historic nurse-patient ratios to be delayed

GIG CONAUGHTON

Staff Writer

California health officials say they probably won't be ready to
impose the nation's first-ever nurse-to-patient ratios for
hospitals by Jan. 1, the deadline mandated by legislation aimed at
reducing the number of patients that nurses can care for per
shift.

Officials with the state Department of Health have been working
to create the new ratios for nearly a year, and expected to release
them for public consideration months ago.

However, with just three weeks left before the Jan. 1 deadline,
those officials are still struggling to create the new ratios, said
Lea Brooks, a spokeswoman with the department.

Brooks said the state could release the ratios in the next three
weeks. She said they also could attach "emergency" language to the
regulations to make hospitals comply by Jan. 1, but she said she
doubts the state will do that.

"It's a very complicated issue," Brooks said, adding that the
state would like to give the public at least 45 days to respond to
the new ratios in public forums across the state before
implementing them.

Nervous hospital officials statewide, who until now have
controlled their own staffing levels, have been anxiously awaiting
the new ratios.

Establishing legal limits

The new rules will put legal limits -- for the first time in
U.S. history -- on the number of patients a hospital can require
each nurse to monitor per shift in as many as 17 hospital
departments. That excludes the intensive and critical-care units,
where previous laws demanded each nurse care for no more than two
patients.

The law, Assembly Bill 394, was signed by Gov. Gray Davis in
October 1999, and will cover acute care hospitals, psychiatric
hospitals and "special hospitals," defined by law as health
facilities with a governing body and adminstration that provides
inpatient or outpatient care in dentistry or maternity.

The new ratios will cover departments ranging from operating and
emergency rooms to delivery rooms, pediatric, cancer and
psychiatric wards.

Requiring hospitals to hire more nurses in the midst of a
national nursing shortage that has already created vacancies
statewide could be asking for the impossible --- and could make
hospitals "criminals" through no fault of their own.

Until the new law takes effect, hospitals officials will
continue to decide for themselves how many patients nurses should
care for based upon "acuity" -- the level of sickness of the
patients in each medical department.

Nurses say it is not unusual for nurses to routinely take care
of between eight and 10 patients per shift.

At least four groups representing nursing unions and hospitals
submitted their own nurse-to-patient recommendations to the
state.

The California Nurses Association recommended the most stringent
recommendations, saying nurses should care for no more than three
patients per shift as a general rule.

By contrast, the California Healthcare Association suggested
that nurses could safely care for six patients in most medical
departments, and up to 12 in others.

Meeting new regulations

Officials from North County's two largest public hospital
districts, Palomar Pomerado Health and Tri-City Healthcare
District, as well as officials from Scripps Hospital in Encinitas,
said they have prepared as much as they can for meeting the new
regulations when they finally arrive.

Leaders at Palomar Pomerado and Scripps said they put extra
money aside in their 2001-02 budgets in case the new ratios
required hiring more nurses.

And in August, both Palomar Pomerado and Tri-City announced
plans to voluntarily reduce their own in-house nurse-to-patient
ratios.

Joy Gorzeman, chief nurse executive at Tri-City Medical Center,
said that was done at the suggestion of nurses working in the
district, and also so that if the new state ratios were stringent,
the district would have already moved in the right direction.

Palomar Pomerado, which runs Escondido's 327-bed Palomar Medical
Center and Poway's 107-bed Pomerado Hospital, decreased the target
level for the number of patients per nurse on its
"medical-surgical" floors -- which account for roughly 70 percent
of Palomar Pomerado's beds -- from eight patients to "five or six"
patients.

Tri-City officials, who run the 397-bed Tri-City Medical Center
in Oceanside, said they reduced their medical-surgery ratios so
that nurses would care for no more than four or five patients per
12-hour shift.

However, officials from both districts said the ongoing nursing
shortage has made it impossible for them to hire enough nurses to
reach those goals.

Palomar Pomerado, Tri-City and Scripps Encinitas don't have
enough nurses to fill out their existing staffs, even though they
report they have had increased success recently in luring new hires
to the area.

Spokeswoman Tamara Hemmerly said the current nursing vacancy
rate at Palomar Pomerado, which would employ 615 nurses at full
strength, is 18 percent.

And the vacancy rate at Scripps Encinitas, said spokeswoman
Janet Lande, is between 10 percent and 15 percent.

Norm Gruber, chief executive officer at Palomar Pomerado, said
hospitals could be caught in a financial squeeze if the state
adopts stringent nurse-to-patient ratios, and hospitals can't find
nurses to hire because of the nursing shortage.

Gruber said hospitals would have to lean more heavily on
expensive nurse-registries to fill gaps, which could cost millions
of dollars and put struggling hospitals into the red.

Nurse registries are similar to temporary services, where
private companies hire nurses interested in working part-time and
off-hour shifts, and sell their services to hospitals -- at higher
pay rates than the hospital's in-house staff -- when hospitals are
short-staffed.

"We wish we could fill all our positions that we have vacant,"
Gruber said.

Meanwhile, Brooks said the nursing shortage has made the
nurse-to-patient ratio legislation more complicated.

"The department is looking at its options," Brooks said.
"Basically, we're still analyzing the information and working on
the draft regulations."